1,721,086 research outputs found
Seminario sulla gestione della terapia farmacologica per l’osteoporosi postmenopausale e senile.3 febbraio,2012
No full textObiettivi del corso : offrire un aggiornamento mirato alla gestione della terapia farmacologica per l’osteoporosi postmenopausale e senile nella pratica clinica ;
La terapia osteoprotettiva oggi ha come fine ultimo la prevenzione delle fratture osteoporotiche. Diversi sono i farmaci disponibili, la Nota 79 è il riferimento normativo che stabilisce l’accesso alla terapia a carico del SSR.
Nell’ambito del seminario saranno illustrati e analizzati con modalità interattiva :
i) aspetti di cost-effectiveness, cioè i parametri da esaminare nel rapporto tra benefici (prevenzione della frattura) e svantaggi (eventi avversi in corso di terapia e costi) che condizionano la valutazione costo-beneficio della terapia antifratturativa,
ii) gli elementi utili per la valutazione comparativa della efficacia dei diversi farmaci disponibili per la prevenzione delle fratture osteoporotiche
iii) gli algoritmi per la stima del rischio assoluto di frattura a 10 anni
iv) il concetto di “soglia di intervento terapeutico” e l’atttuale impostazione della Nota 79
v)presentazione dei dati di sorveglianza sulla appropriatezza dell’intervento terapeutico sulle pazienti afferenti al Centro della Menopausa e dell’Osteoporosi dell’Università di Ferrara in collaborazione con aienda ASL Ferrara
TYPICAL PRESENTATION OF ATYPICAL FEMORAL FRACTURES: A POTENTIAL COMPLICATION OF LONG-TERM BIPHOSPHONATE THERAPY
No full textObjective: In the past years, several cases of unusual fractures have been reported among bisphosphonate-treated woman at sites, such as subtrocanteric or diaphyseal femoral regions, that arenot included in osteoporotic fractures.
Previous thigh pain, lack of trauma prior to fracture and specific radiological characteristics have also been reported.
Suppression of bone turnover and long term use of bisphosphonates can potentially result in increased fracture risk.
Material and Methods: We report 9 cases of atypical metadiaphyseal femoral fractures after long term oral bisphosphonate therapy. All patients were treated with weekly oral alendronate for 6–11 yr and only one patient was administered oral ibandronate in the last year. In 5 patients diaphyseal fracture occurred with little or no trauma and 4 of them reported preceding pain. Fractures were stabilized by intramedullary nailing. Evaluation for secondary causes of skeletal fragility was undertaken.
Results: We found low levels of serum and urinary calcium in all patients. In 6 patients serum 25-hydroxyvitamin D levels were <20 ng/ml and 3 patients had a secondary hyperparathyroidism. One patient had subclinical hyperthyroidism and autoimmune thyroiditis. Three patients had normal BMD measured by DXA. In 4 patients X-rays showed a bilateral femoral involvement consisting of thickening of the diaphyseal cortex and of an abnormal area of increased uptake of controlateral femur at bone scintigraphy. Three of them underwent stabilization of contralateral femur by intramedullary nail fixation. In all patients we found a marked suppression of bone turnover markers.
Conclusion: Our data indicate that concomitant circumstances may affect bone remodelling, beyond the effect of bisphosphonates alone. Therefore, all patients taking oral bisphosphonates should be investigated for secondary causes of skeletal fragility. Radiographic and scintigraphic findings, such as previous thigh pain, are paramount in the early diagnosis of atypical fractures
Balloon-assisted kyphoplasty with calcium-phosphate cement in the treatment of acute burst thoraco-lumbar fractures
No full textThe progressive kyphosis and pain in patients with acute thoracolumbar burst fractures treated conservatively so as the recurrent kyphosis after posterior reduction and fixation were associated to disc collapse rather than vertebral body compression. It depends on redistribution of the disc tissue in the changed morphology of the space after fractures of the endplate. The aim of this study is to evaluate the safety and the efficacy of balloon kyphoplasty with calcium phosphate, alone or associated to short posterior instrumentation, in the treatment of acute thoracolumbar burst fractures.
Eleven fractures in ten consecutive patients with an average age of 48 years who sustained acute thoracolumbar traumatic burst fractures without neurological deficits were included in this study. The fractures were A1.2 (3), A3.1 (4) and A3.2 (4), according to AO classification. In 7 fractures (A1.2 and A3.1) the kyphopasty was performed alone in order to make the most of efficacy in fracture reduction, anterior and medium column stabilization and, as much as possible, segmental kyphosis correction. In the A3.2 fractures (4), that are unstable, the kyphoplasty was associated to a short posterior instrumentation. To avoid the PMMA long run complications in younger patients, we used a calcium phosphate cement. VAS, SF-36, Roland-Morris questionnaire (RMQ) and Oswestry low back pain disability questionnaire (ODQ) were used to evaluate pain, state of health, functional outcomes and spine disability.
To the average follow-up time of 15.5 months (range 8–31) we did not observe statistically significant differences in 7 of 8 SF-36 domains in comparison to general healthy population of same sex and age. At the same follow-up, the spine disability questionnaire showed a functional restriction of 18% (ODQ) and 29,6% (RMQ) being 100% the maximum of disability. No bone cement leakage, no implant failure and no height correction loss were observed in any case.
Our data confirm the safety and the efficacy of ballon kyphoplasty with calcium phosphate in the treatment of acute thoracolumbar burst fractures. In this way we can reduce the possible complications resulted from discal space collapse and obtain an early functional restoration. When performed alone, this mini invasive surgical technique offer the advantage of almost immediate return to daily activities. When associated to posterior instrumentation, it decreases the long run complications and allows to reduce the number of stabilized levels, maintaining, in part, the thoracolumbar junction movement
Tibia fracture healing time correlation with ARRCO score
No full textA multicenter retrospective analysis of patients treated for tibial fracture was conducted to develop a score that correlates with fracture healing time and, ultimately, to identify the risk gradient of delayed healing.
The clinical records of 93 patients treated for tibial fracture at three orthopaedic centers were evaluated. Patients were considered healed when full weight bearing was allowed and no further controls were scheduled. For the purpose of our analysis, we separated patients healed within or after 180 days.
Patient's risk factors known to be associated to delay healing, as well as fracture morphology and orthopaedic treatment were recorded in an electronic Case Report Form (e-CRF). Information available in the literature was used to weight the relative risk (RR) associated to each risk factor; values were combined to calculate a score to be correlated to the fracture healing time: L-ARRCO (Literature-Algoritmo Rischio Ritardo Consolidazione Ossea). Among all information collected in e-CRFs, we identified other risk factors, associated to delayed healing, that were used to calculate a new score: ARRCO. Univariate logistic analysis was used to determine a correlation between the score and healing time. Analysis by receiver operating characteristic (ROC) and calculation of the area under the curve (AUC) were used for sensitivity and specificity.
Complete information was available for 53 patients. The mean value of the L-ARRCO score among patients healed within 180 days was 5.78 ± 1.59 and 7.05 ± 2.46 among those healed afterwards, p=0.044. The mean value of the ARRCO score of patients healed within 180 days was 5.92 ± 1.78 and 9.03 ± 2.79 among those healed afterwards, p<0.0001. The ROC curve shows an AUC of 0.62±0.09 for L-ARRCO and an AUC of 0.82±0.07 for ARRCO, (p<0.0001).
We have shown that the ARRCO score value is significantly correlated to fracture healing time. The score may be used to identify fractures at risk of delayed healing, thus allowing surgeon's early intervention to stimulate osteogenesis
Simultaneous Rupture of Quadriceps Tendon and Contra-Lateral Patellar Tendon: A Case Report and Review of Literature
No full textSimultaneous rupture of quadriceps and contra-lateral patellar tendons represents an extremely rare injury in healthy individuals. Several systemic diseases predispose patients to this type of condition such as chronic renal failure, rheumatologic disease and hyperparathyroidism. However, there are very few cases in the English literature where a healthy individual presents with this condition. The pathophysiology of this disease is not well known despite numerous hypotheses. Sutures with or without anchors of the quadriceps and patellar tendons seems to lead to satisfactory outcome with knee flexion greater than 100°
Quality of life after ballon kyphoplasty for the treatment of osteoporotic vertebral compression fractures
No full textStabilizzazione tendinea dinamica dell’articolazione trapezio-metacarpale con tendine dell’abduttore lungo del pollice nel trattamento chirurgico della rizoartrosi: la nostra esperienza
No full textLa rizoartrosi è una patologia molto ricorrente specialmente nel sesso femminile che
può portare ad un quadro anche di grave deterioramento della funzione della mano.
In questo lavoro sono stati esaminati i risultati a distanza della tecnica chirurgica di
stabilizzazione tendinea dinamica dell’articolazione trapezio-metacarpale con tendine
dell’abduttore lungo del pollice eseguita su una serie di 8 pazienti affetti da rizoartrosi
al II-III stadio secondo Eaton seguiti con un follow-up medio di 17,5 mesi. I
risultati positivi che emergono da questo studio incoraggiano l’utilizzo della suddetta
metodica, che appare di semplice esecuzione, risolutiva della sintomatologia dolorosa,
molto conservativa ed efficace nel limitare la progressione della malattia
Impiego clinico della stimolazione elettrica in ortopedia e traumatologia
No full textLa scelta terapeutica del medico, nel trattamento di patologie dell’apparato muscolo-scheletrico, si fonda su una diagnosi appropriata e sulla scelta della terapia efficace per la patologia in cura. La terapia potrà essere attuata con un farmaco oppure con un dispositivo medico. La terapia con un dispositivo medico per la stimolazione elettrica dell’osteogenesi o della condroprotezione deve garantire:
la sicurezza elettrica del dispositivo;
la sicurezza biologica, intesa come assenza di effetti collaterali;
l’efficacia del dispositivo nella specifica patologia, dimostrata da studi clinici;
l’assenza di controindicazioni specifiche per il paziente che dovrà utilizzare il dispositivo medico.
La letteratura dimostra che l’efficacia terapeutica di un dispositivo medico è legata alle caratteristiche fisiche del segnale elettrico, magnetico o elettromagnetico generato dall’applicatore. Pertanto, l’impiego di un dispositivo deve fondarsi o su documentate esperienze cliniche condotte con il dispositivo stesso o su una chiara dimostrazione di equivalenza con dispositivi che erogano segnali efficaci. Attualmente è presente nel mercato italiano una pletora di dispositivi per “magnetoterapia” o “CEMP”, privi di documentazione clinica che ne documentino l’efficacia e la sicurezza biologica. Questi dispositivi sono proposti ai pazienti per le più svariate e ampie indicazioni: dalla pseudoartrosi alla cellulite. Non è facile se non impossibile per l’ortopedico reperire in letteratura le necessarie informazioni sulle caratteristiche dei diversi dispositivi di “magnetoterapia” o “CEMP”. Indicazioni, controindicazioni ed effetti collaterali sono contenuti unicamente nel manuale di istruzione, che rimanda alla responsabilità del medico l’uso del dispositivo, il quale, in assenza di adeguata documentazione clinica, potrebbe esporre il paziente ad un trattamento inefficace se non dannoso. Nella pratica clinica, la prescrizione all’uso della stimolazione elettrica si deve fondare su una corretta diagnosi e su una specifica indicazione all’uso del dispositivo più idoneo. In questo modo, il medico ottempera al suo dovere di proporre una terapia efficace e sicura
Consideration on disadvantages and problems of resurfacing
No full textThe concept of resurfacing the hip joint is not new, it is a bone conserving alternative to total hip replacement that restores normal joint biomechanics and load transfer and ensures joint stability
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